Normal EKG– P wave: Atrial depolarization– PR interval: < 0.20 sec– QRS complex: ventricular depolarization– QRS interval

< 0.10 sec SA 0.10 – 0.12 supraventricular > 0.12 sec ventricular

Sinus Bradycardia

Pathophysiology: none. It’s a sign of something else.

Criteria:– Rate > 100 bpm– Rhythm: sinus– PR: < 0.20– QRS: normal

Fever, exercise, hypovolemia, adrenergic stimulation.

Sinus tachycardiaSinus tachycardia

Sinus Tachycardia

Sinus Arrhythmia

Pathophysiology: Atrial impulses faster that SA. Reentry pathway

Criteria:– Rate: depends on atrial conduction– Rhythm: irregularly irregular– PR: cant diagnose. No P waves– QRS: narrow

CAD, CHF, vavular disease, hypoxia, drugs

Atrial Fibrillation/FlutterAtrial Fibrillation/Flutter

Atrial Fibrillation

Atrial Flutter

Pathophysiology: ReentryCriteria:

– Rate: > 150 bpm– Rhythm: regular– PR interval: cant see P waves– QRS: Narrow.

Accessory conduction pathway, CAD, COPD, CHF

PSVTPSVT

Paroxysmal Supraventricular Tach

Multifocal Atrial TachMultifocal Atrial TachPathophysiology: Increased areas of

automaticity.Criteria:

– Rate: greater than 120 bpm– Rhythm: irregular– PR: variable (3 or more P waves)– QRS: narrow

COPD

Multifocal Atrial Tachycardia

11stst degree block degree blockPathophysiology: slowed conductionCriteria

– Rate: slow < 60 bpm– Rhythm: regular– PR: > 0.20 second– QRS: narrow

Drugs (av nodal blockers, β-blockers, Ca+2 channel blockers, inferior MI.

1st degree heart block

22ndnd degree block I degree block IPathophysiology: AV nodeCriteria

– Rate: Regular or < 60 bpm– Rhythm: Regular with pause– PR: Progressive lengthing– QRS: narrow (until dropped)

Drugs, parasympathetic tone, RCA

2nd degree type I - mobitz 1 - wenckebach

22ndnd degree block II degree block IIPathophysiology: Below the AV nodeCriteria

– Rate: Different between atrial and ventricular– Rhythm: Atrial – regular, vent – irregular– PR: normal– QRS: narrow (dropped beat)

ACS (LCA)

2nd degree heart block type II – mobitz 2

33rdrd degree block degree blockPathophysiology: no impulses from AtriaCriteria

– Rate: Atrial – 60, ventricular – 40– Rhythm: regular– PR: none– QRS: narrow or wide

ACS (LCA)

3rd degree heart block – complete heart block

Premature Ventricular Contraction - PVC

Multi focal PVC

Bigeminy

Couplets and Triplets

R on T phenomenon

Ventricular Tachycardia

Ventriucular Fibrillation

Asystole